Coaching Intervention to Improve Technical Skill in Surgery Each year in this country more than 150,000 patients undergoing major inpatient surgery die, and many more suffer serious complications leading to major long term morbidity. These important outcomes vary widely across hospitals and surgeons, suggesting large opportunities for improvement. While most improvement efforts have focused on general aspects of perioperative care, emerging evidence suggests that the most important strategy for reducing adverse outcomes of surgery may be to improve the proficiency of the operating surgeon. In this context, we will build on our prior work evaluating technical quality in the Michigan Bariatric Surgery Collaborative (MBSC) to implement a statewide skill development intervention. The MBSC is the perfect laboratory for such a study, with the existing infrastructure to measure technical quality in place, a clinical registry with outcomes data for more than 40,000 consecutive bariatric surgery procedures, and a collaborative network of 70 surgeons from 35 hospitals who have a track-record of participating in both the rating of technical skills and in population-based improvement efforts. Our specific aims are to develop a coaching intervention to improve technical skill and to evaluate its impact on surgical skills and clinical outcomes. Thi study will be highly innovative as the first large-scale study to apply coaching to improve technical skills among practicing surgeons. Results from this study will have immediate impact on surgeons, policymakers, and patients in need of surgery. Surgeons can build on this work to further augment large-scale quality improvement programs to focus on improving technical skill. Policy makers could develop similar programs and encourage surgeons to participate in them to achieve accreditation or board-certification. Ultimately, patients will be the beneficiaries of thi research as their surgeons become more skilled and they suffer fewer postoperative complications.